Understanding cancer treatment decision making among cancer survivors.

Abstract

e24076 Background: Nearly 20% of U.S. cancer survivors develop late cardiovascular disease (CVD) as a result of cardiotoxic cancer treatments. Patients and providers may consider alternative treatment options to lower cardiotoxicity risk, which may present a trade-off between reducing relatively near-term relapse/recurrence vs. preventing long-term CVD. Patients’ decision-making processes (e.g., delay discounting, risk perceptions for CVD vs. cancer) may affect such choices. However, these decision-making factors are not well understood in this context; nor is their association with treatment selection. Methods: In a cross-sectional survey using the online survey vendor Prolific, we recruited 443 U.S. cancer survivors (any type.) Using logistic regression, we assessed how survivors’ risk perceptions (deliberative, affective, and intuitive) for cancer vs. CVD were associated with decisions between two hypothetical cancer treatments involving different risk tradeoffs: Treatment 1: 5% chance of near-term cancer recurrence & 10% chance of CVD; Treatment 2: 10% chance of near-term cancer recurrence & 5% chance of CVD. We explored effects of delay discounting by randomizing participants to information describing immediate vs. delayed (10 years post-treatment) development of CVD. Results: Survivors ( Mage = 48, range 18-93) were, on average, 10.8 years from diagnosis. More survivors ( 72% v. 28%) chose Treatment 1 (lower cancer recurrence risk but higher risk of cardiotoxicity) than Treatment 2 (lower risk of cardiotoxicity but higher risk of cancer recurrence) . Immediacy of CVD development (immediate vs. delayed) was not associated with treatment selection (p = 0.12.) Modeling separately, higher levels of affective risk perception (“worry”) about cancer, but not worry about CVD, was associated with increased odds of choosing Treatment 1 ( OR= 1.25, p= 0.014.). Modeled together, cancer worry was associated with increased odds, whereas CVD worry was associated with decreased odds, of choosing Treatment 1 ( OR-cancer= 1.35, p= 0.002; OR-CVD= 0.76, p= 0.011). Neither deliberative nor experiential risk perceptions were significantly associated with treatment choice. Conclusions: Cancer survivors were more likely to select treatment that minimizes cancer recurrence rather than comparative CVD—regardless of the described immediacy of cardiotoxicity. Further, treatment decision also depended upon both cancer- and CVD-related worry but not deliberative or experiential risk perceptions. Comparatively to CVD, cancer is often more affectively-laden, especially among cancer survivors. These results suggest that in treatment discussions, clinicians may need to address not only the probabilities of treatment outcomes, but patients’ relative worries about cancer and cardiotoxicity.